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Barriers to Contraceptive Use Among Urban Adolescents and Youth in Conakry, in 2019, Guinea

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Barriers to Contraceptive Use Among Urban Adolescents and Youth in Conakry, in 2019, Guinea ORIGINAL RESEARCH published: 15 July 2021 doi: 10.3389/fgwh.2021.655929 Barriers to Contraceptive Use Among Urban Adolescents and Youth in Conakry, in 2019, Guinea Nafissatou Dioubaté 1*, Hawa Manet 1, Charlotte Bangoura 1, Sidikiba Sidibé 1,2, Mariama Kouyaté 2, Delphin Kolie 1,2, Alison M. El Ayadi 3 and Alexandre Delamou 1,2 1 Maferinyah National Center for Training and Research in Rural Health (CNFRSR), Forécariah, Guinea, 2 Africa Center of Excellence for Prevention and Control of Communicable Diseases (CEA-PCMT), University Gamal Abdel Nasser, Conakry, Guinea, 3 Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States Background: Despite efforts to improve access to family planning, contraceptive prevalence remains relatively low among adolescents and youth in Guinea. The objective of this study was to understand the barriers to the use of modern contraceptive methods among urban adolescents and youth (15–24 years) in Conakry, Guinea. Edited by: Methods: This was a qualitative study using an exploratory design. It was conducted James Duminy, University of Bristol, United Kingdom in the capital city of Guinea, Conakry in 2019. Respondents included adolescents and Reviewed by: youth aged 15–24 years, health care providers, and parents of adolescents and youth. Heidi Johnston, In-depth individual interviews (IDIs) and focus group discussions (FGDs) were used to Independent Consultant, Switzerland Cecilia Milford, collect the data. Sixty IDIs and ten FGDs were planned in Conakry. These data were University of the recorded and transcribed, when applicable, from the local languages into French in an Witwatersrand, South Africa anonymous manner. The data were analyzed using a mixed (inductive and deductive) *Correspondence: thematic approach following the elements of the socio-ecological model. Nafissatou Dioubaté [email protected] Results: Overall, 56 IDIs and 10 FGDs were conducted with 136 participants and included in this analysis. Respondents were adolescents (16%), youth (30%), and key Specialty section: This article was submitted to informants (54%) who were health care providers (public and private), decision-makers, Contraception and Family Planning, parents of adolescents and youth, and neighbors. Among adolescent respondents, a section of the journal Frontiers in Global Women’s Health 75% were female, and of the youth, 61% were female. Our analysis indicates various Received: 19 January 2021 and interrelated barriers that limit the access and use of contraceptives by adolescents Accepted: 04 June 2021 and youth. These included the individual (fear of side effects, cost, and rumor-related Published: 15 July 2021 misinformation), interpersonal or family (spouse perception and sexuality taboo and Citation: perception of sexual activity before marriage), sociocultural (religious prohibitions and Dioubaté N, Manet H, Bangoura C, Sidibé S, Kouyaté M, Kolie D, ethnicity), and health care system (breakdown of contraceptive methods in public health Ayadi AME and Delamou A (2021) facilities, perception of service delivery, provider attitudes, visiting hours, geographic Barriers to Contraceptive Use Among Urban Adolescents and Youth in proximity of services, and quality of training received by health care providers) barriers. Conakry, in 2019, Guinea. Conclusion: In our context, the use of modern contraceptive methods by adolescents Front. Glob. Womens Health 2:655929. and youth is influenced by an interaction of various barriers, including individual, doi: 10.3389/fgwh.2021.655929 interpersonal, sociocultural, and health care system factors. Strengthening contraceptive Frontiers in Global Women’s Health | www.frontiersin.org 1 July 2021 | Volume 2 | Article 655929 Dioubaté et al. Barriers of Contraceptive Use Among Adolescents uptake interventions by involving different stakeholders, including adolescents, parents, religious, and community leaders, and improving the quality of sexual and reproductive health services would help in reducing barriers to contraceptive use among adolescents and youth. Keywords: barriers, contraceptive, urban, adolescents and youth, family planning, Guinea BACKGROUND creation of FP access points in health areas by integrating FP into reproductive health services (post-partum care, post-abortion Sexual and reproductive health issues, including unwanted care, expanded program of immunization, nutrition, etc.), the pregnancies, remain a significant public concern in sub-Saharan extension of the community-based service approach to rural Africa (1, 2). According to a report published in 2016 on the and peri-urban areas, the organization of special FP days and “Costs and Benefits of Meeting the Contraceptive Needs of integrated campaigns, the strengthening of the training program Adolescents,” an estimated 21 million girls between the ages of and equipment, and the reinforcement of the capacity of 25% of 15 and 19 become pregnant each year in developing countries, the providers to be able to offer FP services adapted to teenagers and about 12 million of them give birth to children (3, 4). At and young people. Despite these efforts, modern contraceptive least 10 million of these young people face unwanted pregnancies prevalence is low in Guinea (11%). This prevalence varies among each year in these countries (3). However, complications during sexually active young women, ranging from 10.3% among those pregnancy and childbirth are the leading cause of death for girls aged 15–19 to 11.4% among those aged 20–24 in 2018 (30). aged 15–19 worldwide (5, 6). However, in the same year, 20% of 15–24-year-olds had an unmet In 2019, more than 842 million women of childbearing age need for family planning (27, 30). were using contraceptive methods, and 270 million women It is therefore relevant to understand the barriers to the use worldwide did not have access to contraceptive methods they of modern contraceptive methods among adolescents and youth. needed (7, 8). However, less than half of the need for family This information can help to significantly reduce unwanted planning (FP) was met in sub-Saharan African countries (3). pregnancies and their consequences, but also promote their well- In addition, adolescents and youth often face difficulties being and improve their living conditions not only now but also in accessing contraceptive services (9, 10). The results of in the future (32). The purpose of this study is to explore the some studies conducted, particularly in developing countries, perception of personal, interpersonal, community, and health on the obstacles related to the use of modern contraceptive system barriers that influence the use of modern contraceptive methods among adolescents and youth suggest that particular methods among sexually active urban adolescents and youth in attention should be paid to individual difficulties, interpersonal, Conakry, Guinea. community, or cultural influences (11–20). Adolescent girls also face many barriers, including fear, embarrassment, lack of knowledge, and cost of services, limiting the use of these methods METHODS (11, 12, 21, 22). Furthermore, factors such as quality of and access Study Framework to health services or age restrictions when seeking FP services The socio-ecological model was used to deconstruct our influence adolescents and youth access and use of contraceptive finding on barriers of contraceptive use among adolescents methods (23–26). and youth in urban Guinea (32). This model describes the It is also possible that with the demographic explosion and rapid urbanization of African capitals, young people find it more access and utilization of modern contraceptives as a result difficult to access health services in these areas because of the of four inter-related factors. The first comprises individual low adaptive capacity of health systems, including low geographic factors such as age, gender, and economic status. The second access in health areas, poor quality of services due to the lack layer includes interpersonal factors such as the nature of the of training and equipment, inadequate services for adolescents relationship between two or more people, including friends, and youth, shortages of contraceptive methods, especially in parents, communities, and health workers. The third includes private health facilities, etc. (27). Studies have also reported health sociocultural factors such as religion, customs/cultural behavior. care provider bias, and community judgment toward adolescents The last layer is related to organizational and health system and youth when seeking FP services, as well as concerns about factors such as the availability and quality of services, including confidentiality (13, 14, 28, 29). contraceptive methods. In Guinea, adolescence is defined as the period of age between These different factors interact in complex ways and influence 15 and 19 years. This period corresponds to the moment that access to modern contraceptives and the behavioral outcome of sexuality begins (30, 31). Out of the 12 million inhabitants their use among adolescents and youth (13). that the country accounted for in 2019, about 2 million live in Conakry, and of these, 16% are adolescents and youth, making it Study Design a significant subpopulation (31). In the past years, many efforts This was a qualitative study using an exploratory design. Data have been undertaken to improve FP in Guinea, including the were collected for six months from June to December 2019. Frontiers in Global
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